Real Men
Real Depression
Cheryl A. Clark, MD
Distinguished Fellow, American Psychiatric Association
Diplomate, American Board of Psychiatry and Neurology
Medical Director
Clinical Director
Mental Health Center of Denver
4141 E. Dickenson Place
Denver, CO 80222
303-504-6500
www.mhcd.org
Facts about Depression
About 20.9 million American adults have
depression.
It can happen to anyone, no matter what age
you are or where you come from.
Real Men
Real Depression
Until puberty boys and girls show similar
depression risks.
After puberty girls are 2 x more likely to become
clinically depressed.
But MEN GET DEPRESSED!
Frequency of Depression
In the US in one year depressive illnesses affect:
12 % of women= 12 million women
7 % of men = > 6 million men
What is depression?
A serious medical condition often accompanied by
physical symptoms such as:
Weight loss or gain
Difficulty falling asleep or waking up during the night or
waking up very early in the morning.
Decreased concentration or inability to concentrate
May have profund memory impairments-pseudodementia of
depression
Feelings of guilt which may even reach psychotic proportions
Decreased energy-trouble getting out of bed
Feelings of leaden paralysis
Decrease in sexual interest
What is depression?
Body, Mind and Spirit are affected
It is more than a passing blue mood
It is not a sign of personal weakness or a condition
that can be will or wished away
Symptoms are present nearly all day every day for at
least 2 weeks.
Symptoms of Depression
Persistent sad, anxious, or empty mood
Feelings of helplessness, pessimism
Feelings of guilt, worthlessness and helplessness
Loss of interest or pleasure in hobbies and
activities once enjoyed
Decreased energy, fatigue, being “slowed down”
Difficulty concentrating, remembering, making
decisions
Symptoms of Depression
Trouble sleeping, early-morning awakening or
oversleeping
appetite and/or weight changes (gain or lose weight)
Thoughts of death or suicide, or suicide attempts
Restlessness, irritability
Persistent physical symptoms, such as headaches,
digestive disorders, in chronic pain, but do not respond
to retain treatment
Facts about Depression
A common illness
Often begins between ages 15 and 30, but also
seen in children and the elderly
World Health statistics from 2001 state that in
2000 depression was the leading cause of years
lived with a disability among men and women of
all ages in the US and worldwide
Neuroscience of Depression
Just as your automobile has brake fluid,
antifreeze, transmission fluid, and oil - your
brain runs on these neurotransmitters. Some
give us energy, like those related to adrenalin,
some control body movements ("dopamine" as
an example), and some control mood
(serotonin).
Causes of Depression
The human brain operates, much like your
automobile, on fluids called neurotransmitters.
Causes of Depression
Serotonin is a neuortransmitter that is important
in mood regulation.
Causes of Depression
Genetics:
Depression seems to run in some families
Serotonin transporter gene: 5-HTTLPR
abnormalities
Associated with Depression
Significant stress and loss
Other medical illnesses: heart disease, stroke, cancer,
chronic pain, diabetes, HIV, Parkinson’s, etc.
Chronic medical problems
Traumatic events-PTSD
Panic disorder
Obsessive Compulsive Disorder
Substance Abuse
Types of Depression
3 main types of depression
Major Depression: variety of symptoms that
severely interfere with ability to work, study, sleep,
eat and enjoy life. May occur only once, but is more
likely to be recurrent.
Dysthymia: less severe and not as likely to be
disabling
Bipolar Depression (manic-depressive illness):
primary feature is mood instability with mood
cycling between severe highs and lows.
WHO statistics
450 million people worldwide are affected by mental,
neurological or behavioral problems at any time.
About 873,000 people die by suicide every year
Mental illnesses are common to all countries and cause
immense suffering. People with these disorders are often
subjected to social isolation, poor quality of life and
increased mortality.
One in four patients visiting a health service has at least
one mental, neurological or behavioral disorder but most
of these disorders are neither diagnosed nor treated.
Source: WHO website http://www.who.int/mental_health/en/ accessed 2/13/2007
Global Burden of Disease
U.S. Department of Health and Human Services,. Mental Health: A Report of the Surgeon General-Executive
Summary, Rockville, MD: US Department of Health and Human Services, Substance Abuse and Mental Health
Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of
Mental Health, 1999.
Burden of Mental Illness
In the United States, mental disorders collectively
account for more than 15 percent of the overall burden
of disease from all causes and slightly more than the
burden associated with all forms of cancer (Murray &
Lopez,1996).
These data underscore the importance and urgency of
treating and preventing mental disorders and of
promoting mental health in our society.
Mental Health: A Report of the Surgeon General. Washington, D.C. Department of Health and Human Serivces,
US Public Health Service, 1999.
Scope of the Problem
Suicide statistics from the Colorado Deparment of Public
Health and Education 2006 data:
Suicide is the 7th leading cause of death in
Colorado
Suicide is the leading cause of injury death in
Colorado.
More people die of suicide than are killed in motor
vehicle crashes.
On average, 720 individuals die by suicide and 2,560
are hospitalized for attempted suicide each year.
Scope of the Problem
Females ages 15-24 have the highest rate of
suicide attempt.
The majority of suicide deaths involve the use of
a firearm (52 percent).
The majority of hospitalizations for suicide
attempt involve drug overdose (81 percent).
> 4 times as many men as women die by suicide
in the US.
Treatments for Depression
Anti-depressants
Psychotherapies-CBT, IPT
Abstain from alcohol and drugs or limit intake if
depressed
ECT
VNS
Herbal therapy: National Center for
Complementary and Alternative Medicine
(http://nccam.nih.gov/)
What can you do?
Seek medical advice and evaluation
Rule out other causes of depression
Call the 24 hour hotline if you or someone you
know is struggling with suicidal thoughts.
National Suicide Prevention Lifeline @ 1-800-273-
TALK (1-800-273-8255)
What can you do to help yourself?
DO NOT IGNORE DEPRESSION
Engage in mild exercise.
Go to a movie, a ballgame, or participate in religious,
social, or other activities.
Set realistic goals and assume a reasonable amount of
responsibility.
Break large tasks into small ones, set some priorities,
and do what you can as you can.
Try to be with other people and to confide in someone;
it is usually better than being alone and secretive.
What can you do to help yourself?
Expect your mood to improve gradually, not
immediately. Feeling better takes time. Often during
treatment of depression, sleep and appetite will begin to
improve before depressed mood lifts.
Postpone important decisions. Before deciding to make
a significant transition–change jobs, get married or
divorced–discuss it with others who know you well and
have a more objective view of your situation.
What can you do to help yourself?
Do not expect to ‘snap out of’ a depression. But
do expect to feel a little better day by day.
Remember, positive thinking will replace the
negative thinking as your depression responds to
treatment.
Let your family and friends help you.
Seek the advice of a spiritual counsellor if you
have one.
References and Resources
Men and Depression:
www.menanddepression.nimh.hin.gov/
Men and Depression: A detailed booklet that
describes what you need to know about depression in
men: how it looks, how it feels, getting help, and getting
better. (2005)
http://www.nimh.nih.gov/health/publications/men-
and-depression/summary.shtml